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Accumulator - View By Claim

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Health Center:
Pharmacy:
Capture Date :
To:


Health
Center
Pharmacy
ShipTo
Claim
Type
RX
Number
Member ID
Fill
Fill Date
Adjud
Date
Captured
Date
NDC
Drug
Name
Strength
Form
Pkg
Size
QTY
Disp
Curr
QTY
% of
Claim
Status
Status
Date
Order
Wholesaler
Invoice
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780871 MR003577650003/29/202103/29/202103/30/202161314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786216 MR003344950011/12/202111/12/202111/13/202161314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1001958724 3073746995
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786275 MR003235800011/17/202111/17/202111/18/202161314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1001961629 3074284779
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786278 MR002487490011/17/202111/17/202111/18/202161314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1001961629 3074284779
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786785 MR000262510012/09/202112/09/202112/10/202161314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1001971456 3076588673
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787167 B8CC73RGCFA30012/23/202112/23/202112/24/202161314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788424 MR003235800002/21/202202/21/202202/22/202261314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1002008728 3084278400
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789115 MR002814350003/22/202203/22/202203/23/202261314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1002024556 3087532840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789355 MR002484860004/04/202204/04/202204/05/202261314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1002031219 3088846711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789588 MR000649240004/15/202204/15/202204/16/202261314062810POLYMYXIN B-TMP EYE DROPS10000-1/MLDROPS101010100.00000Replenished 1002036633 3089903741